BACKGROUND The golden standard treatment for amblyopia is patching the better eye. Visual acuity improvement of the amblyopic eye is significantly impacted by adherence of the patching therapy. It is known that the overall adherence is rather low. OBJECTIVE This retrospective study evaluated whether an updated version of attention binding digital therapeutic games based on the principle of focal ambient visual acuity stimulation (FAVAS) would result in an improved patient adherence in 4- to 16-year-old patients with amblyopia. METHODS We analyzed pseudonymised electronically recorded data from patients treated with occlusion therapy and FAVAS therapeutic games. One group used an older (2015) and the other group the newer version (2020) that provided more attractive therapeutic games with tablet computer functionality. Objective adherence was calculated by comparing the amount of minutes using the therapeutic games as monitored in the automatized logbook versus prescribed minutes of using the games. RESULTS Children in Group 2015 (n=138) spent on average 2009.3±1372.1 (36 to 5472) minutes using FAVAS; children in Group 2020 (n=129) spent on average 2695.5±1526.8 (37.5 to 5672) minutes using the improved therapy. Group 2020 spent on average 686.2 more minutes on FAVAS than Group 2015 (t=3.87, P<.001). Although patient adherence was very variable, compared to the 57%±34% in Group 2015, it significantly improved up to 78%±46% in Group 2020 (t=4.3, P<.001). CONCLUSIONS FAVAS 2020 with an improved gamification aspect as well as tablet computer functionality increased adherence significantly compared to the earlier version FAVAS 2015, indicating that FAVAS 2020 could be an effective approach to support adherence to amblyopia treatment. CLINICALTRIAL DRKS00017633

Purpose To compare the binocular vision status of patients pre‐ and post‐cataract surgery, and to investigate the risk factors for patients who develop binocular vision anomalies post‐surgery. Methods A prospective study of patients (≥50 years) who elected to undergo bilateral cataract surgery was implemented. A comprehensive binocular vision test battery including stereopsis, ocular alignment, fusional vergence, vergence facility, near point of convergence and the Convergence Insufficiency Symptom Survey (CISS) was administered before the first surgery and at the third visit after surgery on the second eye. A detailed diagnostic classification protocol was applied to identify the presence of binocular vision anomalies pre‐ and post‐surgery. Results Seventy‐three participants were included at baseline, 24 (33%) of whom were diagnosed with non‐strabismic binocular vision anomalies (NSBVA), mainly convergence insufficiency (18/73, 25%). Fifty‐one participants completed the post‐operative evaluation, 17 (33%) of whom had NSBVA pre‐surgery and 13 (26%) post‐surgery (p = 0.48). There were a number of conversions from NSBVA to normal binocular vision and vice versa. Logistic regression showed that the adjusted odds ratio of pre‐existing NSBVA diagnosis for predicting the risk of post‐operative NSBVA was 6.37 (p < 0.01). There were no significant changes in most binocular vision measures post‐surgery, except for a significant improvement in the CISS score (p < 0.01, Cohen's d = 0.83). Conclusions Binocular vision anomalies, especially convergence insufficiency, are prevalent in the age‐related cataract population. Cataract surgery does not appear to be a significant risk factor for the development of new binocular vision anomalies. A pre‐existing binocular vision anomaly is the main risk factor for predicting a post‐operative binocular vision anomaly in this population.

Background The gold standard treatment for amblyopia is patching the better eye. Improvement of visual acuity in the amblyopic eye is significantly impacted by the adherence to the patching therapy. It is known that the overall adherence is rather low. Objective This retrospective study evaluated whether an updated version of attention-binding digital therapeutic games based on the principle of focal ambient visual acuity stimulation (FAVAS) would result in improved patient adherence in 4- to 16-year-old patients with amblyopia associated with anisometropia or strabismus. Methods We analyzed electronically pseudonymized recorded data from patients treated with occlusion therapy and FAVAS therapeutic games. One group used an older version (2015) and the other group used a newer version (2020) that provided more attractive therapeutic games with tablet computer functionality. Objective adherence was calculated by comparing the number of minutes using the therapeutic games as monitored in the automatized logbook versus the prescribed number of minutes for using the games. Results Children in group 2015 (n=138) spent on average 2009.3 (SD 1372.1; range 36-5556) minutes using FAVAS; children in group 2020 (n=129) spent on average 2651.2 (SD 1557.1; range 38-5672) minutes using the newer version. Group 2020 spent on average 641.9 more minutes on FAVAS than group 2015 (t255.49=3.56, P<.001, d=0.45; 95% CI 0.69-0.20). Although patient adherence was very variable, compared to the 55.0% (SD 29.4%) in group 2015, it significantly improved up to 68.5% (SD 33.7%) in group 2020 (t254.38=3.48, P=.001, d=0.44; 95% CI 0.68-0.19). Conclusions FAVAS 2020, with improved gamification aspect as well as tablet computer functionality, increased adherence significantly compared to the earlier version of FAVAS 2015, indicating that FAVAS 2020 could be an effective approach to support adherence to amblyopia treatment. Trial Registration German Clinical Trials Register (DRKS) DRKS00017633; https://drks.de/search/de/trial/DRKS00017633